Under federal law, you have a guaranteed issue right to buy a Medicare Supplement insurance plan (also known as MedSupp or Medigap) during the Medigap Open Enrollment Period, which begins the first month you have Medicare Part B and are age 65 or older. This means that during this six-month enrollment period, insurers cannot turn you down or charge you more because of a pre-existing health condition*.
After the Medigap Open Enrollment Period, insurers can refuse to sell you a Medigap policy, delay coverage, or charge you a higher premium because of an existing health condition. The insurance company may also ask you to submit to a medical underwriting process and deny you coverage or charge you a higher rate based on its findings.
There are some exceptions to the rule, however. In some situations, you have the guaranteed-issue right to buy a Medicare Supplement policy outside of your Medicare Supplement Open Enrollment Period:
- You have a Medicare Advantage plan, and the insurance company has left your service area.
- Your Medicare Advantage plan has been discontinued or is leaving Medicare.
- You have moved out of your Medicare Advantage plan’s service area.
- You currently have Original Medicare, and your employer coverage is ending.
- You have Original Medicare coverage and a Medicare SELECT plan, and you move out of the Medicare SELECT plan’s service area.
- You lose your Medicare Supplement insurance plan because the insurance company went bankrupt.
- You end your Medigap coverage because the insurance company misled you or was not compliant with the law.
You may qualify for guaranteed issue into a Medicare Supplement insurance plan, regardless of your medical history, if you meet certain criteria such as applying during your Medicare Supplement Open Enrollment Period. Additional guaranteed issues rights may be available and are dependent on your state of residence.
There are additional reasons that may qualify you for a “trial right” to purchase a Medigap policy. For this reason, you should shop around and check with the individual insurance company in your state to see if changing Medicare Supplement insurance plans is possible in your situation.
Will I have to wait for coverage after changing Medigap plans?
After changing Medigap plans, you may have to wait to receive coverage for certain benefits. If this is outside the Medigap Open Enrollment Period and you have a pre-existing condition* (assuming the insurer lets you make the switch), you may have to wait to be covered for expenses associated with that condition. The wait time for coverage of your pre-existing coverage can be up to six months.
Also, if after changing Medigap plans, the new plan offers benefits that aren’t covered under your current plan, you may have to wait up to six months to be covered for those new benefits as well.
Do I have to change Medigap plans if my older policy has been discontinued?
You do not have to change plans just because your Medigap policy is no longer offered. Older Medigap policies have different coverage than plans being currently sold. For example, Medigap policies sold after January 1, 2006, no longer include prescription drug coverage, but if you purchased your plan before then, you can keep the older policy. You may want to hang on to your older Medigap policy if it includes coverage for prescription drug expenses, and changing Medigap plans would dramatically increase your out-of-pocket costs for prescription drugs.
At the same time, keep in mind that newer, current Medicare Supplement insurance plans may have additional advantages not included in your older plan, such as guaranteed renewable policy or a lower premium. It is important to weigh your present health needs and compare plans to find the best fit for you.
If you decide to cancel your older policy (outside of the 30-day “free look” period), you cannot get it back since it is no longer available as a standardized Medigap plan.
Can I change my mind about switching Medicare Supplement insurance plans?
If you decide to change Medigap plans, you can still keep your old plan for up to 30 days before canceling it. You must promise to cancel the old Medigap plan when filling out the application for the new plan, but you’re allowed a 30-day “free-look” period, in case you opt against changing Medicare Supplement insurance plans. This period begins when you start your new policy. You should not cancel your old plan until you are sure that you want to keep the new policy.
Be aware that you’re required to pay both premiums during the 30-day “free-look” period.
Can I add Medigap after leaving a Medicare Advantage plan?
If you are currently enrolled into a Medicare Advantage plan, and it is illegal for insurance companies to sell you a Medigap policy if you have a Medicare Advantage plan.
This does not mean you have missed your chance to ever enroll in a Medicare Supplement insurance plan. Your Medigap Open Enrollment Period begins the first month that you enroll in Medicare Part B — not the first month you are eligible for Medicare. So if you delayed your enrollment in Medicare Part B, or if you canceled your automatic enrollment when you first turned age 65, you may still have the guaranteed-issue right to enroll in Medigap when you’re ready for Medicare Part B.
If you already had a Medigap plan and then dropped it when you switched to a Medicare Advantage plan, you may be able to get the same plan back if you go back to Original Medicare within one year. This is your “trial right” to try a Medicare Advantage plan. If your old Medicare Advantage plan is no longer available when switching back, then you can purchase Medigap Plan A, B, C, F, K, or L with guaranteed issue, that’s sold by any insurance company in your state.
Can I drop Medigap if I have a Medicare Advantage plan?
You should drop your Medigap plan if you enroll into a Medicare Advantage plan since you cannot use Medigap benefits while enrolled in a Medicare Advantage plan. It is illegal for companies to try to sell you Medigap when you are already enrolled into a Medicare Advantage plan.
However, if you already have a Medigap plan, you have the right to hang on to it if you think you may want to return to Original Medicare, Part A and Part B, in the future. Keep in mind that you will still have to pay the Medigap premium, even though Medigap does not cover any out-of-pocket expenses when you’re enrolled in a Medicare Advantage plan. Your Medigap policy cannot be used to pay for premiums, copayments, or deductibles for your Medicare Advantage plan.
Check with your state’s insurance website or Medigap insurers in your area to see if guaranteed-issue Medigap plans are available. If chances are good that you can get guaranteed issue later, then it might not be worth keeping your current Medigap insurance and paying the monthly premium without being able to use the plan’s benefits.
Do you have more questions? Connect with any of our licensed insurance agents to answer your Medicare questions or discuss a Medicare plan option that may be right for you.
This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.
*Pre-existing conditions are generally health conditions that existed before the start of a policy. They may limit coverage, be excluded from coverage, or even prevent you from being approved for a policy; however, the exact definition and relevant limitations or exclusions of coverage will vary with each plan, so check a specific plan’s official plan documents to understand how that plan handles pre-existing conditions.